Olecranon bursitis

Last revised by Pir Abdul Ahad Aziz Qureshi on 24 Nov 2023

Olecranon bursitis refers to inflammation of the olecranon bursa. The olecranon bursa is a subcutaneous sac that overlies the olecranon process and contains a small amount of fluid to prevent injury of subcutaneous tissue and skin from the uncovered bony olecranon.

The presentation is with a tender, fluid-filled olecranon bursa. In cases associated with infection, there may also be overlying inflammatory skin changes (e.g., erythema) and systemic symptoms (e.g., fever) 4.

Bursitis can develop secondary to many causes:

Lateral radiographs of the elbow reveal soft tissue swelling superficial to the olecranon 4. An olecranon spur may also be visible 4. A clue to the underlying etiology may also be present, such as traumatic fracture or calcification in gout or CPPD 4.

Ultrasound may show a fluid collection in the olecranon bursa, features of synovial proliferation and/or hyperemia. A small proportion of patients may also show the presence of an associated loose body or features of associated triceps tendinopathy (+/- calcifications) 2.

  • fluid density at the subcutaneous tissue superficial to the elbow

Bursal fluid collection has the following features:

  • T1: hypointense

  • T2: mainly hyperintense

  • C+ (Gd): enhancement of bursal margins

Triceps brachii muscle and subcutaneous edema as well as elbow joint effusion may be seen.

Olecranon bursitis is generally managed conservatively with supportive treatments such as resting, intermittent icing, compression, and simple analgesics (e.g. acetaminophen, NSAIDs) 4. Aspiration of the bursal fluid is generally not required and carries risks (e.g. infection, sinus tract creation), and should be reserved if there is a suspicion of an unusual etiology such as underlying infection 4. Surgical bursectomy is a treatment of last resort in cases refractory to the aforementioned treatments 4.

Generally, the condition is self-limiting over weeks and there are generally no chronic sequelae if managed conservatively 4.

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